LAKE MAX TRIATHLON In Beautiful Culver, Indiana

CONSENT AND RELEASE By entering this event and signing below, I accept all risks associated from my participation that could result in the loss of life or permanent injury. Accordingly, I release all people associated with the conduct of this event from and will indemnify them against all liability (including liability for negligence) for all injury, loss, damage arising out of or connected with my participation in this event. The people released include but are not limited to event organizers, promoters, sponsors, the Culver Academies and the City of Culver and its homeowners, supporters, and all public authorities. I understand that the safety precautions undertaken at the vent by organizers are a service to me but are not a guarantee of my safety. I will provide event organizers all details of my past and present medical 0r physical conditions that may affect my performance or be relevant if medical treatment is necessary. I consent to event organizers using my name, image, likeness, before, during or after the event for promotional broadcasting or reporting purposes in any media.

Thank you to our sponsors!

John Zeglis Family

American Party Time (tent)

Culver Coffee Company

Lake House Grille

Brockey Insurance

Preventative Medicine

Culver Storage

Miller Merry Manor

CJM Photography

Equilibrium Fitness

Hole in the Woods (lip balm)

Town and Country Liquors

Hosted by the CULVER ACADEMIES

Lake Max Triathlon August 8, 2015 at O8:30 AM 400 Meter Swim 12 Mile Bike 5K Run

All proceeds will be directed to the Culver Lions Club, Culver Kiwanis Club, Culver Club of Culver and Culver Boys and Girls Club

__________________________ Signature of participant 18 years or older _____________________________

Kids Triathlon

Signature of Parent or Legal Guardian Date:_______________

August 8, 2015 at 10:00 AM

Amount Enclosed: $___________ Send the attached form with check payable to: CEF-Lake Max Triathlon Dana Neer, Race Director Culver Academies 1300 Academy Road # 88, Culver, IN 46511 Phone: 574-842-8080/765-252-7030 E-mail: [email protected]

Culver Club of Culver

Ages 5-7: 50 meter swim, 1 mile bike, 12 mile run Ages 8-10: 75 meter swim, 2 mile bike, 1 mile run Ages 11-12: 75 meter swim, 2 mile bike. 1 mile run

PACKET PICK UP

TRANSITION AREA

Packet pick-up will be from 6:30 a.m. 8:00 a.m. Participants must attend a mandatory pre-race meeting at 8:10 am.

Only participants are allowed in the

LOCATION The event will be held on the beautiful campus of Culver Academies. Address: 1300 Academy Road, Culver, Indiana TEAM RELAY Teams can consist of 2 or 3 participants; they can be same gender or co-ed. Each team member must submit registration form. All registration forms must be sent together. TIMING AND SCORING Timing and scoring will be done by TH Timing from Valparaiso, IN using the chip timing system. RACE REGULATIONS Swim caps will be provided. Wetsuits are permitted if water temperature is 78 degrees or below on race day. Bike helmets are required. No drafting allowed on bike, BIB numbers must be visible at finish line. Participants must finish the course for an official time.

PLEASE PRINT AND CHECK

transition area. Participants must

Individual

Male

pick up their own bike and equipment

Team (must submit a form for each member)

and the area will be guarded until

Kids

-

Female

-

-12

completion of race.

AWARDS Awards will be given to top 3 overall male and female finishers. The top female, male and co-ed teams will

For teams please chose one: Male

Female

Co-ed

Team Name: ______________________

also be given an award. Age group

Name: _________________________

awards will be 5 year increments

Birth Date: _______/_______/________

starting at age 10.

Age as of 8/9/15: ______

SHIRT

Address : _________________________ City: __________________ State: _____

All participants registered by July 28

ZIP: _________________

will receive a dry-fit shirt.

Phone: __________________________ E-mail: __________________________

REGISTRATIONS Pre–register at Actiive.com or mail registration to:

by July 28 with amenities, $75 from July 29th-August 4th with no amenities Registration Closed on August 4th, 2015.

Dana Neer, Race Director

by July 28 with amenities, $125 from July 29th-August 4th with no amenities Registration Closed on August 4th, 2015.

Culver Academies,

for kids registration and the fee must be received by August 4th, 2015

1300 Academy Road #88, Culver, Indiana 46511

Shirt Size (Circle One): S M L XL XXL Kids Shirt Size (Circle One): YS YM YL S M